Tuesday, 26 July 2011

Migraine in Children

Published in Panorama

Migraine in children

Until recently it was believed that only teenagers and adults get Migraine. However, the fact is, children, as young as five or six years of age can be victims of this nagging headache, reveals Dr.Saifuddin, Ophthalmologist, Al Musalla Medical Centre, Dubai. Says the specialist, “We may attribute the headache to tension headache, refractive errors, glasses, strain at the school; but we are missing out the base line: that the headache could actually be Migraine! However, if we diagnose Migraine at a very early age, it might not worsen at a much later stage. Therefore it is very important that diagnosis of the correct form of headache be reached at the earliest.”

The factors contributing to migraine in children are many and varied. They include environmental factors like excessive heat, cold, stress and faulty diet among other factors. Diet plays a very important role in the conditions, emphasizes Dr.Saifuddin. “Excess of chocolate, fizzy drinks, coffee and tea may also make a child prone to migraine. Recent studies indicate the Chinese Restaurant Syndrome where Monosodium Glutamate (MSG) in Chinese preparations has been proven to precipitate migraine. Say for instance, a family has eater Chinese food in a restaurant and after one or two days, any member or members of the family start getting a headache. This is typically seen in a number of instances where MSG is implicated in migraine and most fast foods have contain MSG.”

Dr.Saifuddin further reveals, “Use of the computer for more than two hours at a stretch, can precipitate migraine, according to recent studies.”

How does migraine actually happen? Dr.Saifuddin explains the process, “The blood vessels in the brain are in the process of getting constricted; so the blood supply to the brain is diminished. To compensate for the diminished blood supply, the brain will try to get sufficient blood from all over the body. And that’s when a person starts feeling all kinds of discomfort in the body including stomach pains, limb aches, lethargy.

These symptoms appear because the brain is drawing blood from all other sources. Therefore, by taking drugs like panadol, further constriction of the blood vessels is prevented and present constriction is arrested. The blood vessels assume their normal size, get dilated and the pain is relieved. For how long the bouts of migraine last in an individual, varies from person to person. While some may have the attack for only a couple of hours, others may have it for even a week. In the case of young children, till the blood vessel gets back to its normal position, they may suffer from the headache and even eye pain.”

What are the symptoms of migraine in kids and how are they different from other types of headaches? Well, herein lies the problem, admits Dr.Saifuddin. “While the risk factors are not too many at that young age, the malady itself affects a child’s noraml work, routine studies and play. You cannot differentiate the symptoms from other forms of headaches in kids though this is simple to do so in adults. Because migraine usually involves a one-sided, dull ache which might make you not want to go out anywhere or do anything. But a child is unable to express this feeling; hence the difficulty in diagnosing it. However, initially, migraine in kids is not different from any other headache type; it is only when the child grows, the symptoms become distinguished from other headache forms.”

Typically, migraine headache is one-sided and the individual is not inclined to do anything. There may be some blurring of vision, though this happens in the later stage when the person has already had migraine for five or six years. However, diagnosing migraine is by exclusion, ruling other dental and other problems which could give rise to head aches in general. Often, children with migraine, present with vomiting and abdominal pain, which symptoms may actually lead to a wrong diagnosis!

Is it possible for children to have different types of migraine? ‘Yes, though it is very difficult to categorize migraine types in children,” reveals Dr.Saifuddin. “For instance, a child might have ophthalmic migraine. In this condition, besides the blood supply to the brain getting diminished, the blood supply to the eye is also restricted. So the child will start getting blurring of vision and even some sort of blackout. The child will not want to sit in a brightly lit room, be in the presence of sunlight and prefer to remain in a dark room. In fact, even noise can precipitate a migraine attack in children.”

How would migraine be diagnosed, for instance, in a six year old child? The major diagnostic tool is through questioning the child and parents, opines Dr.Saifuddin. “We have to rule out other conditions. Of course, there is no hard and fast rule that the child is suffering from migraine. We majorly base the conclusion of migraine on the basis of diagnosis by exclusion. We advise the parents to maintain a headache diary, to make relevant associations and identify and isolate the possible triggers to the condition.”

If migraine is not diagnosed in a six year old who is suffering from bouts of headache, for instance, it is possible that it could flare up in severity and frequency in young and later adulthood, reveals Dr.Saifuddin. “This also implies that if caught early, it can be treated appropriately and even cured.”

How is migraine treated in children? The first and foremost measure to be taken in instances when migraine is suspected is to maintain a migraine diary to identify possible triggers. Once such triggers are identified, the best treatment is avoidance of these substances or triggers, especially if they are items of food. “There are medicines to treat the condition but there are not 100% safe for use in children,” reveals Dr.Saifuddin. “So advice, educate and motivate the parents and child on all the triggering factors and how best to avoid them.”

Where the triggers are environmental in nature, it may not be possible to avoid them and the only treatment modality may be symptomatic for the pain. “But parents can certainly help to de-stress their children by not pushing them unduly to perform in academics and thereby pressurize them beyond their coping capacity.”


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